Vaccines: Science versus Sense

Book review on

Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure

by Paul A Offit MD

Reviewed by Peter Mansfield, 2009 published in Network Review No 100

 This book is written by someone acknowledged widely in the USA as expert in the field of vaccination. He rails against a battalion of people he considers to have misled the public and profited from the doubts they sowed. I suppose, if he knew I existed, he would include me. I find it impossible to address his case line by line. It rests on a blow-by-blow account of the passage through committees and the media of claims and counter-claims for the safety and or efficacy of various vaccine combinations. These are themselves legion, and it was always improbable that a simple conclusion could be drawn from the tale. There is, rather, a simplistic mood running through: that vaccine critics are fanatical, threatening, unscientific and wrong.

          My own position started in 1988 when the MMR combination was introduced. As a GP I took against this development, but needed time to realise why. It was because MMR combines three live vaccines representing acute systemic viral diseases, i.e. they attack the whole body rather quickly. However these viruses have another property, which is mutual intolerance: they can only colonise a particular body one at a time. Forcing not two, but three of them on a child simultaneously created a challenge potentially harder to overcome than what nature might have posed. It created a new situation, analogous with the more extreme forms of genetic manipulation: it broke the basic rules.

          Vaccination should, surely, always be a safer and more convenient than accepting the natural risk, or else why do it? Why should we ever risk the health of a child in the name of a health service?

          Dr Offit neglects this question. He assumes that infection is always bad, and believes that vaccination is one of the great pillars of public health practice. I don't entirely disagree, but each vaccine deserves to be appraised in the light of this question.

          Very few of our current offerings pass that test with flying colours. Most are against diseases which had been defeated by public hygiene before vaccines came along. Dr Offit's two main contentions fall at the first hurdle.

          He does not question that manufacturers no longer wish to make single vaccines against measles, rubella or mumps. The reasons why not are commercial, not health enhancement. Were the option available, more people would accept some or all of them, and the total vaccination rate would be more acceptable to the powers that be. In any case combining these three at age one is seriously ill-conceived: only measles can be justified. Rubella and mumps protection can and should await the onset of puberty, when the diseases begin to be hazardous. Mumps occurs only once but the vaccine needs a boost about every ten years, which now causes a substantial number of students to catch mumps in their late teens. The Department of Health still attributes this to inadequate vaccination in infancy: it's actually because most children formerly had the disease, and life-long protection, before school entry.

          His other major topic is the use of mercury compounds to preserve killed vaccines. The practice has now ceased, but he believes the evidence does not demonstrate medium-term harm from multiple injections of small doses of mercury.

          But is that the point? Why choose something so dubious, and why persist once the original need (protection of multi-dose vials, now superseded by single dose packs) has fallen away? Chiefly, I suspect, because manufacturers and public health bodies cannot afford to admit it was a mistake.

          This book fails to dissuade me that public health authorities in the USA and UK are now shamefully uncritical of what companies wish to market. Our public health policy is dictated by share price. No amount of well-meaning science can bring that to book.

 

(order this book from amazon.co.uk)